This invention relates to surgical devices for anastomosis procedures requiring the union of luminal structures of the body, such as bile ducts and blood vessels, and more particularly, relates to coupling devices which eliminate the use of suture materials for coupling such vessels in surgical procedures.
In order to perform diversified anastomotic procedures without the use of sutures, coupling devices have been developed to secure the free ends of the tubular tissue members to be joined, as described in U.S. Pat. Nos. 2,453,056, 3,254,650, and 4,214,586. The anastomotic devices described in these patents are typically coupling tubes or rings adapted for attachment to the free ends of the tubular tissues which are everted to expose the luminal interior or intima of the ends of anastomotic repair.
U.S. Pat. No. 2,453,056 describes a three-piece anastomotic apparatus which can be employed to join the end of one vessel to the side of another vessel, but requires the portions of the incised sidewall of the second vessel to be held by multiple forceps while the end of the first vessel is inserted into the incision. Only thereafter can the incised portions of sidewall be mounted on the tubular member holding the everted end of the first vessel. The end-to-side anastomosis described in this patent is a portal caval shunt operation in which the end of a portal vein is joined to a vena cava. The complicated procedure requires multiple foreceps to hold the incised and everted wall of the vena cava, but in addition, the surgeon's finger must be placed under the vena cava during the insertion of the end of the portal vein which previously has been prepared by eversion upon a tubular device. Thus, the procedure requires not only holding the "cut lips" of the vena cava by the use of foreceps but, additionally, requires retention in the forceps in order to move the lips onto the tube carrying the end of the portal vein, and continued retention in the forceps during the subsequent securement of the lips on the tube by a clamping ring. Since only the end of the portal vein is secured on a coupling device prior to completion of the anastomosis junction, multiple instruments are required to manipulate the lips of the vena cava in order to complete the junction.
U.S. Pat. No. 3,254,650 does not teach side-to-end anastomosis but does describe a pair of "self-aligning" discs or sleeves 126 and 128 with preformed, alternating, axial pins 130 and axial passages 132 which receive the pins from the other disc (see FIGS. 10-22). The pins pierce the everted respective ends of the vessel to retain the ends thereon, and when the discs are pressed together, the everted ends are clamped between the discs. Subsequently, the protruding ends of the pins must be bent over in order to secure the discs together.
U.S. Pat. No. 4,214,586 also uses three elements for end-to-end anastomosis of tubular vessels. Here, to cylindrical adaptor are connected by a cylindrical sleeve-like member locking appendages which cooperate with gripper recesses for completing the anastomosis.